The CQC have recently requested that stakeholders in the health and social care sector take part in a survey to help frame their strategy for 2021 and beyond. This survey has been published as part of the CQC’s project on “Smarter Regulation” on the citizenlab portal. The CQC says of the project:
“We want to make regulation simpler but dynamic to reflect the changes in health and social care we can anticipate, as well as those we cannot. We will be more effective and efficient and use intelligence to tailor our actions to individual services, targeting our resources where we can have the greatest impact.”
Given the vast impact of the COVID-19 pandemic on the sector, it is perhaps a sensible time in any case for the CQC to take stock and consider how best to regulate going forwards. We welcome reform to better, more effective regulation which is more supportive of those in the sector.
The CQC are currently operating under its Emergency Support Framework (ESF). Since periodical routine comprehensive inspections were suspended in March 2020, the CQC have been “crossing the threshold” in services only which they deem to be at high risk, largely based on data and information it has obtained through the ESF or other intelligence gathering activity. As COVID-19 restrictions loosen, inspection activity is ramping up again. The ESF has been widely championed by the CQC as enabling its intelligence gathering functions to move forward at significant pace and it is likely that the CQC will want to build on this in determining what the “new normal” post COVID-19 will look like.
The CQC intend to have a Transitional Support Framework (TSF) in place to cover a period of time after the ESF and whilst we do not yet have the details of what this will entail, we expect some form of hybrid between the ESF and the pre-COVID-19 approach. We expect this will continue to be geared towards intelligence gathering and to build on the methods, processes and tools which the CQC have adopted for the ESF.
It had been expected that the CQC would resume its regular periodical comprehensive inspections of services at some point. However, some of the questions posed in the survey could suggest that the CQC are looking to change their approach to deciding when to inspect, and whether or not to announce inspections. The survey asks, for example:
“Are unannounced inspections a useful tool to drive improvement in the quality of care at a service?”
“Do you think a risk-based approach to inspections is more effective than scheduled inspections, in keeping people safe? (ie. risk-based means we make decisions about whether to inspect on intelligence we gather about a service and the level of identified risk)”
Routine comprehensive inspections have in the past been scheduled according to a prescribed timescale. Inspections were expected to take place within 30 months of publication of a report for a service rated Good or Outstanding, within 12 months for a service rated Requires Improvement, within 6 months for a service rated Inadequate and within 6-12 months of registration for a previously unrated service. Of course, if the CQC deemed an inspection was necessary for other reasons or they had concerns, it could re-inspect at any time, but providers had a pretty good idea when to expect their next comprehensive inspection.
Whilst we can only speculate, the CQC seem to be asking whether stakeholders support a change to in its approach for scheduling comprehensive inspections, and for all inspections to be unannounced. This may indicate that they are intend to move away from prescribed timescales and towards a fully intelligence-led timetable.
As with the CQC’s wider agenda to be more intelligence-led, whether or not this is a good thing will largely depend on the quality of the data and information that the CQC are gathering and – perhaps more importantly – how they actually apply it. The upside to being intelligence led is that a regulator can better assess risk in real time, and can become better at regulating as it does so; it becomes a more “intelligent” regulator so to speak. However, this presupposes that the intelligence gathered will be put to sensible use, properly verified, and that it will be used as a basis for reasonable and proportionate decision making.
It is all very well mining lots of data and information butut the extent to which that will have a positive impact on the CQC’s operations, practices and procedures remains to be seen. It is important that data and information gathered from third parties, for example, can be reasonably verified before it is allowed to impact on the CQC’s assessment of risk. Providers have limited oversight at present so it is difficult to analyse whether the CQC are actually becoming more “intelligent” in all this. The CQC still needs to apply common sense, be reasonable and act proportionately as a regulator.
It would be helpful if the CQC were to provide more transparency to the sector as to what data it is gathering, how it is assessing the quality of that data and, critically, how it is making decisions based on it. Without this information, the CQC leaves itself open to an increase risk of challenge to the conclusions it draws – a feature of it’s already not wholly transparent approach and something that Ridouts sees on a daily basis. To do so might help providers understand the likelihood of an unannounced inspection arising at any particular time if the pre-existing schedules will no longer apply. It might also give some more hints as to what the CQC-provider relationship might look going forwards in a “new normal”.
The future remains somewhat uncertain. Routine comprehensive inspections scheduled according to past ratings may be a thing of the past. The intelligence-led approach looks set to feature more and more in CQC’s regulatory activity. However, to determine the full impact that a change in approach will have on providers in practice, and how provider should respond, we will need to watch this space.
Providers who wish to take the survey can do so via the CQC Citizenlab portal available here.
For assistance with, or advice on CQC matters, providers can contact Ridouts Professional Services plc on 0207 317 0340. We frequently advice providers on factual accuracy and rating challenges often securing amendments.